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Sterility of anesthetic and resuscitative drug syringes used in the obstetric operating room.

UNLABELLED: Because of the constant threat of emergent cesarean delivery, anesthetic induction and resuscitation drugs are often drawn into syringes and stored in the obstetric operating room (OR). This study investigated the potential for bacterial and fungal contamination of six drugs (thiopental, succinylcholine, ephedrine, atropine, lidocaine, and oxytocin) often prepared in the obstetric OR. A total of 756 drug syringes were prepared and stored in the obstetric OR for 8 days using normal clinical practices. Starting on Day 0, and subsequently on Days 4 and 8 of the experiment, 42 syringes of each drug were randomly selected from the pool, filtered through a 0.45-microm porosity sterile cellulose filter, and cultured on 5% sheep blood agar. Of the 756 syringes tested, none grew organisms of any type, which indicates a probability of drug sterility of > or = 0.9961 (95% confidence interval [CI]). The data from the cultures performed on syringes on Day 0 indicate a probability of initial contamination of < or = 0.018 (95% CI). This study demonstrates a high probability of sterility in drugs drawn into sterile syringes and stored at room temperature in an OR environment for up to 8 days. IMPLICATIONS: Drug syringes stored in emergency operating rooms are discarded after 24 h because of possible contamination. We searched for microorganisms in drug syringes stored in the operating room for up to 8 days. No microbes were detected using standard sterility testing techniques. Adopting longer storage periods could result in significant cost savings.

Anesthesia, Obstetrical↗

Manual record-keeping and statistical records for the operating room.

Surveys have shown that handwritten anesthesia and circulating records kept in hospital operating rooms may be inadequately maintained and analyzed. Online, fully automated data processing techniques have been applied to reduce the anesthesiologist's recordkeeping workload, but with limited receptivity. An off-line data processing system has been developed using handwritten records to provide both anesthesia and operating room utilization statistics. Evaluation of the system indicates that an online, semiautomated approach applied only to charting vital signs and recording utilization statistics is an appropriate one for future development.

Anesthesia↗

Issues regarding parents in the operating room during their children's care.

The presence of parents in the operating room does have possible legal ramifications. Taking an upset child from a parent's arms, however, is not a positive situation either. Perioperative nurses should not automatically weigh legal implications more heavily than the patient benefit that may be derived from the presence of parents. Whether parents should or should not be allowed to accompany their children into the operating room should be a carefully considered institutional policy.

Child↗

[Air cleanliness in operating rooms: on-site controls and biological testing].

Air cleanliness control in operating rooms is based on air filtration, and targets the lowest density of particules and bacteria. Legally, the equipment must be periodically verified during periods of inactivity. Most airborne bacteria are of human origin. There is no fixed ratio between the particle count and the level of bacterial contamination. A study of different types of operating room at Besançon Medical Center reached the following conclusions:--Controls are also required during periods of activity.--Bacteriological testing is crucial.--Unidirectional airflow, especially of the horizontal type, is superior to other forms of isolation. The authors propose a "Functionality index", calculated as follows: bacterial count during use of the room minus bacterial count during non use/the number of people in the room. Efficient equipment would have a low index, which would be unmodified by the number of persons present.

Air Microbiology↗

[Working conditions in the operating room: surgeons surveyed during the annual meeting of the German society of surgery 2004].

For the evaluation of working place conditions in the operating room a survey was conducted among the surgeons working in German hospitals. Questions regarded the personal profile, the architectural situation, the devices and instruments as well as the working posture. The answers to the 60 questions display a high potential for improvement within all fields. Every single group working in the operating room, as well as their professional organizations are asked to work on the optimization of the working place conditions in the operating room in terms of improvement of quality and efficiency.

Data Collection↗

Distribution system for controlled substances in the operating room.

A system of drug distribution for controlled substances in a hospital operating room is described. Problems in accountability for and accessibility to controlled substances distributed by a floor stock method led to the new system. Small, lockable narcotic cases contain a sufficient quantity of Valium, Innovar, ans Sublimaze for one shift. Each nurse anesthetist signs out a narcotic case from the pharmacy at the beginning of the shift and is responsible for its contents until it is returned to the pharmacy at the end of the shift. Administration records are dept by the nurse anesthetist. A discrepancy in the count results in an incident report automatically and an investigation. The system has improved the drug distribution process in our operating room and is easily adaptable to other institutions.

Humans↗

The impact on revenue of increasing patient volume at surgical suites with relatively high operating room utilization.

UNLABELLED: We previously studied hospitals in the United States of America that are losing money despite limiting the hours that operating room (OR) staff are available to care for patients undergoing elective surgery. These hospitals routinely keep utilization relatively high to maximize revenue. We tested, using discrete-event computer simulation, whether increasing patient volume while being reimbursed less for each additional patient can reliably achieve an increase in revenue when initial adjusted OR utilization is 90%. We found that increasing the volume of referred patients by the amount expected to fill the surgical suite (100%/90%) would increase utilization by <1% for a hospital surgical suite (with longer duration cases) and 4% for an ambulatory surgery suite (with short cases). The increase in patient volume would result in longer patient waiting times for surgery and more patients leaving the surgical queue. With a 15% reduction in payment for the new patients, the increase in volume may not increase revenue and can even decrease the contribution margin for the hospital surgical suite. The implication is that for hospitals with a relatively high OR utilization, signing discounted contracts to increase patient volume by the amount expected to "fill" the OR can have the net effect of decreasing the contribution margin (i.e., profitability). IMPLICATIONS: Hospitals may try to attract new surgical volume by offering discounted rates. For hospitals with a relatively high operating room utilization (e.g., 90%), computer simulations predict that increasing patient volume by the amount expected to "fill" the operating room can have the net effect of decreasing contribution margin (i.e., profitability).

Computer Simulation↗

Comprehensive performance management in the operating room.

A clearly defined method for measuring and analyzing operating room (OR) processes provides a common language for focusing management's attention on areas of variability that can be eliminated. But hospitals must also assess OR performance against multiple financial aid and clinical quality metrics to achieve continuous improvement in patient outcomes and profitability enterprisewide. This project is a collaborative effort by McKesson Information Solutions and the Healthcare Financial Management Association.

Benchmarking↗

Exposure of operating room personnel to nitrous oxide during paediatric anaesthesia.

This study was undertaken to quantify the exposure of operating room staff to nitrous oxide during routine paediatric otolaryngeal surgery and to determine the influence of the method of induction of anaesthesia on this exposure. The nitrous oxide exposure of the anaesthetist, the surgeon and the circulating nurse were measured, using body-worn passive atmospheric samplers, during twelve routine paediatric otolaryngeal surgical lists. During six of the lists an inhalational technique, with nitrous oxide, oxygen and halothane, was used for the induction of anaesthesia. During the other six lists anaesthesia was induced using intravenous thiopentone. In all cases, anaesthesia was maintained using nitrous oxide, oxygen and halothane. Regardless of the induction technique used, the mean nitrous oxide exposures of the anaesthetist, the surgeon and the nurse all exceeded the maximum level of 25 ppm.hr-1 recommended by the United States National Institute for Occupational Safety and Health (NIOSH). The use of an intravenous technique for the induction of anaesthesia reduced the nitrous oxide exposure of the anaesthetist and the circulating nurse. This suggests that, although the use of an intravenous induction may reduce exposure to nitrous oxide, the NIOSH recommendations for maximum exposure of operating room personnel to nitrous oxide are currently unattainable in practice.

Adult↗

[Techniques for evaluating the level of pollution in operating rooms due to gaseous or volatile anesthetics].

To evaluate the air pollution in operating rooms when anesthesia is carried out with an open-circuit anesthesia delivery system, two analyzers were tested both in the laboratory and in an operating room. The TIF 5500, a laptop instrument, allows the detection of gas with low ionisation potential such as chloro-fluorocarbons (lower detection threshold: 3 ppm). The Bruel & Kjaer 1302 allows the simultaneous determination of the concentrations of the different inhalation anesthetics in the room by photoacoustic spectrometry. For this type of study, the latter proved an excellent instrument.

Air Pollutants, Occupational↗

Forecasting surgical groups' total hours of elective cases for allocation of block time: application of time series analysis to operating room management.

BACKGROUND: Allocation of the correct amount of operating room (OR) "block time" can provide surgeons with access to sufficient OR time to complete their elective cases while optimally matching staffing with the elective case workload (to maximize labor productivity). To evaluate how to predict accurately total hours of elective cases performed by a surgical group using data from surgical services information systems, the authors addressed the following questions: (1) How many previous 4-week periods of data should be used to minimize error in forecasting a surgical group's total hours of elective cases? (2) Using the number of 4-week periods from question #1, can we detect trends or correlations between successive periods that could be used to improve forecasting accuracy? (3) How can results from questions #1 and #2 be used to calculate an upper prediction bound (upper limit) for the total hours of elective cases that will be completed in a future period? Prediction bounds can be used to budget staffing accurately. METHODS: Time series analysis was performed on total hours of elective cases over 39 consecutive 4-week periods from 17 surgical groups. RESULTS: The average of 12 consecutive periods' total hours of elective cases had an appropriate error profile. The observations within each series of 12 consecutive 4-week periods followed a normal distribution, with each observation of total hours of elective cases not correlated with the subsequent observation. CONCLUSIONS: The average of the most recent 12 4-week periods can be used to predict surgical groups' future use of block time.

Algorithms↗

[Ensuring safety from explosions in the operating room].

To prevent explosions and fires in operating room the possible reasons for their appearance were considered. The most dangerously explosive zones were classified, and recommendations were given concerning the equipment for these zones to avoid explosive situations.

Explosions↗